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  • Title: Combined detection of urinary biomarkers noninvasively predicts extent of renal injury in patients with early diabetic kidney disease with kidney qi deficiency syndrome: A retrospective investigation.
    Author: Wu W, Meng XJ, Wan BY, Fang QJ, Liu YL, Wang J, Fu Y, Yuan CC, Wang MZ, Chong FL, Wan YG, Shen SM.
    Journal: Anat Rec (Hoboken); 2023 Dec; 306(12):2945-2957. PubMed ID: 34910381.
    Abstract:
    Incipient diagnosis and noninvasive forecasts using urinary biomarkers are important for preventing diabetic kidney disease (DKD) progression, but they are also controversial. Previous studies have shown a potential relationship between urinary tubular biomarkers (UTBs) and traditional Chinese medicine (TCM) syndrome in patients with DKD. Thus, we further evaluated the clinical significance of combined detection of urinary biomarkers in noninvasively predicting the extent of renal damage in patients with early DKD with kidney qi deficiency syndrome, and preliminarily explored the potential biological link between UTBs and TCM syndrome in DKD. We categorized 92 patients with Type 2 diabetes mellitus into three groups as follows: 20 patients with normoalbuminuria, 50 patients with microalbuminuria, and 22 patients with macroalbuminuria. We found that, in all groups, 24 hr urinary albumin (24hUAlb) and urinary albumin-to-creatinine ratio (UACR) showed stepwise and significant increases. Urinary cystatin C (UCysC), urinary N-acetyl-β-d-glucosaminidase (UNAG), and urinary retinol-binding protein (URBP) synchronously increased gradually, consistent with the degree of albuminuria in all groups. Moreover, 24hUAlb and UACR were positively correlated with UCysC, UNAG, and URBP, respectively. In 72 patients with Type 2 DKD with albuminuria, a positive correlation was observed between UNAG and URBP, UCysC was also positively correlated with UNAG and URBP, respectively. Additionally, TCM syndrome distributional characteristics in all patients were consistent with clinical manifestations of kidney qi deficiency syndrome. Therefore, the combined detection of UCysC, UNAG, URBP, and UAlb may be used as a practical clinical technique to noninvasively forecast the extent of renal injury in patients with early Type 2 DKD with kidney qi deficiency syndrome. UTBs may be one of the biological bases of the specific TCM syndromes in DKD. 通过尿生物标志物进行早期诊断和无创性预测对于预防糖尿病肾病(DKD)的进展是重要的，但是，也是有争议的。既往的研究显示，尿肾小管生物标志物(UTBs)与DKD患者中医证候之间有潜在的联系。因此，我们进一步评价尿生物标志物的联合检测在无创性预测早期DKD肾气虚证患者肾损伤程度中的临床意义，并初步揭示UTBs与DKD中医证候之间的潜在生物学联系。将92例2型糖尿病患者分为以下3组，正常白蛋白尿组20例患者，微量白蛋白尿组50例患者，大量白蛋白尿组22例患者。我们发现，在各组患者中，24hUAlb和UACR呈现出逐步而明显的升高。尿胱抑素C(UCysC)、尿N-乙酰1-β-D-氨基葡萄糖苷酶(UNAG)和尿视黄醇结合蛋白(URBP)均显示出逐渐的升高，这与各组患者白蛋白尿的程度相一致。而且，24hUAlb、UACR 与 UCysC、UNAG 和 URBP 分别呈正相关。在72例伴有白蛋白尿的2型DKD患者中，UNAG与URBP呈正相关，UCysC也与UNAG、URBP分别呈正相关。此外，所有患者的中医证候分布特征均与肾气虚证的临床表现相一致。因此，UCysC、UNAG、URBP和UAlb的联合检测可作为一项无创性预测早期2型DKD肾气虚证患者肾损伤程度的实用临床技术。UTBs可能是DKD患者特定中医证候的生物学基础之一。.
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